Barely Swimming: Systemic Burdens that Ravage Nurses
A nurse recounts her daily experiences on the hospital floor.
November 21, 2017
Image from Readers Digest
The floor is chaos.
Not enough nurses on shift. Julia* called out sick this morning and an RN from 7 West who put in for overtime ended up a no-show. Our manager isn’t around, in a meeting or at lunch after popping in at 10:00 with a dapper “hello” and calling us in for a mandatory 10:30 huddle (in the middle of our biggest medication pass) to tell us about the upcoming Christmas party. We throw each other looks when she mentions the $90 price tag to RSVP. She closes with grand rounds on “fascinating nursing research topics” that we’re all invited to; of course none of us will make it because we will be slaving away on the floor.
11:55: I’m mixing antibiotics for a patient who came in with neutropenic fever overnight. We push them over 2-5 minutes via IV because of a normal saline shortage caused by Hurricane Maria. Several weeks ago, management and infection control informed us that we had to be more sparing with the mini-bags and discontinue all “keep vein open” fluids because major Baxter facilities in Puerto Rico were knocked out by the superstorm.
I pull the antibiotics into a syringe, yellow and foaming, and my mind roves to the next items on my list: notify MD of critical lab for 7A, pull methadone for 7B, find IV pump and hang fluids for 10A, return phone call to 8A family member, find out hemodialysis slot for 8B, make sure 9A is chugging the go-lightly for her colonoscopy (and not pouring it down the toilet), fetch blanket for 9B…
“Shit. Forgot the flush.”
I spin around to grab a 10-cc saline syringe from my cart swoop into the room. Over the next two minutes, I hear about the patient’s work as a massage therapist, her maltese Rick and how she quite enjoys her newfound baldness after her last run of chemo.
Walking out the room, I glance over at my co-worker Elisa, two months into her first nursing job. She looks pale, her lips dry and cracked–dehydrated after 5+ hours without a sip of water. She catches my eye and timidly asks for my help setting up a tube feed. Dammit. To-do list on hold.
“You got all the stuff? Let’s go.”
We grab a few tins of the beige stuff and a new feed bag. The patient is on contact, so we gown up before going in. He’s inaudible after having his voice box removed; a few days ago, he had a mass the size of a golf ball lodged in his throat. I see a marker gripped in his hands and phrases scribbled on a whiteboard resting on his lap: “Soy de Cuba. Dolor. Donde esta el doctor. Llame al Victor.” We hang the feed, label the bags and tubing, show the patient how to swish and spit an anti-fungal and reposition him in bed.
Before leaving, I empty two urinals hanging off the bed rails and call out, “About 725 cc’s, babe. You okay with the rest?” Elisa throws me a grateful look and nods as I rip off the gown and walk out.
What’s next? Oh yeah, page doc.
I stop to pee on the way to the nurses’ station to page the doc. My movements are brisk, mechanical, and measured–nothing extra. I breathe as I relieve myself, Elisa’s stricken face is on my mind.
I feel for her and the newer ones. This is not a place to ask questions and learn. No one is there to guide you gently by the elbow. This is a place to survive, hustle and grind.
Later in the break room, I shared my thoughts with a co-worker who’s been on the unit for over eight years. He shook his head, “I know. I’m barely swimming.”
They say the old eat the young in nursing, but that’s not the whole story.
We depend on each other. When the floor’s empty cuz we’re chronically short staffed, we pair up to do cares, dressing changes, and ambulate patients. When a nurse breaks down sobbing in the supply closet because she feels overwhelmed, we hug her, change her assignment, and say, “You’ll get through this.” When a patient crashes, it’s everyone’s. We depend on each other to eat, sit, stay emotionally intact.
Even still, we end up feeling abandoned or unsupported. The overwhelming demands of the job don’t give us much breathing room to jump in when someone else is in the weeds. It forces us to get tunnel-visioned. We all know teamwork is necessary, but oftentimes we come out looking more like lone wolves calling out into the wild: “Anybody out there? Can someone help me?”
The real beast ripping into our flesh and breaking our backs are the hospitals and healthcare system itself. I reach a point almost every shift where I tell myself, “This is insane. We need more support. I hate this shit.” Probably a useless meditation.
But it boils down to conditions being brutal and unsustainable for nurses. Unlike what they said to reassure us in nursing school, it doesn’t just get easier with experience.
At my last job, I remember coming home with ankles swollen, back and calves throbbing from a night shift of hauling hundreds of pounds in essentially dead weight. We were chronically short of nurses, patient care technicians, housekeeping, clerks – every department was stripped to skeletons. Being a public hospital, I guess we had De Blasio and Cuomo to especially thank for that. I would clock out two, three hours past shift to finish minimal charting for up to 12 patients.
One morning, I bumped into a veteran nurse I knew in the hall. Miss James was old school as old school gets: wore her nurse’s hat, crisp knee-length skirt, white stockings, and Guyanese accent proudly. I floated to her unit a few weeks back and she looked out for me, gave me the code to the bathroom, showed me where they kept the hypos. She wore a mini portable fan around her neck “to keep me cool when it heat up” and carnival beads as a lanyard. Her back was straight as a rod and she stalked through the unit like someone who handled it.
That morning, she looked wrecked. After a tight hug, she looked into my eyes with her tired ones.
“Nam, I can’t do this. This killing me. Eleven patients. It’s getting worse and they don’t care.” She threw a dark look toward the office we just walked out of – the managers sat inside, television on, watching as nursing staff clocked in and out.
*Names and personal details have been altered.